Tuesday, September 13, 2011

The nursing office at RCHM is white. The only decoration on the walls is a large poster (thoughtfully provided by a drug company) illustrating locations for intramuscular injections. The over all effect is less reminiscent of interior decorating magazines circa 1995 and instead screams "we're too lazy to decorate."

So I brought a small picture of my family and put it up on top of the bookshelf."Do you have to do that?" GoodbyeNurse asked. "I hate looking at pictures of people I don't know."Guess I shouldn't have given him that pep talk about being more assertive and sticking up for himself!

Monday, August 8, 2011

Drug reps visit our office often. They tell us all kinds of things about their product in the hope that the doctors will prescribe it. Some of it may even be true.

Last week, the rep for Meltthevoices came to visit. As far as antipsychotic drugs go, it's pretty effective, and comparatively cheap. (Only seven hundred dollars a month!) Unfortunately, the people at MegaDrugs who designed it didn't think the design process through completely. The concept that if you're going to have a medicine taken by dissolving under the tongue you may want to think about how it tastes apparently never crossed the creators' minds. Within six months of FDA approval, the company nearly stopped making it because the patient reaction to the taste was so negative.

So I asked the drug rep about this.

"I got so many complaints about the taste that I even tried a small sliver of a 5mg tablet to see what they were talking about--and it was really bad--"

"Well, yes, but I took it at bedtime and didn't have anything planned for the next day in case it made me too sleepy to do anything." He abruptly remembered his spiel. "And that's why it now comes in MegaBerry flavor!"

GoodbyeNurse raised an eyebrow inquiringly.

The drug rep sighed. "Yes, I tried it too. It's definitely an overpowering fruity berry flavor, but it's way better than the original."

Saturday, July 16, 2011

At the "Difficult Cases" staff meeting last month, we were discussing how best to re-engage Mr.Incredibly Unhappy with our services. He had stopped taking his medications some time before, and had decompensated to the point where he was having multiple weekly contacts with the RC Sheriff's office for being a public disturbance.
Barry had an idea. "LuAnn is his case manager. I'm sure she can take care of it!"
LuAnn had different plans. "I'm rubber, you're glue, everything you say bounces off me and sticks to you!

Wednesday, June 29, 2011

IntimidatingShrink has been a forensic psychologist for a long time. In addition to doing standard mental health assessments on inmates, he also gets to do competency and "how likely are you to re-offend" exams. He keeps us posted whenever "our people" wind up in the criminal justice system.

I got a call from him the other day."You have a Not Quite Bright on your caseload, right?""Yeah..." I've got about ninety people on my caseload. It takes a minute to remember who's who without accessing our computer records."You may want to put his case on hold for a few months. He's back in jail in methpossession charges."This surprised me. "He just was in last month on meth charges. Did he jump bail?""Mr. Bright got arrested yesterday when he went to his court date for last month's meth charges. He actually had more meth in his pockets that he brought to court!"

Sunday, June 19, 2011

One of the therapists retired last week. As we usually do, the department threw her a going-away party. People brought lots of cakes and pies and side dishes.

And two golden retriever puppies.

They were about eight weeks old; at that stage where they're all fluffy and big-eyed but still waddle and occasionally fall over their own feet when they walk. I'm still not sure why they were there (or even who brought them) but they sure were cute!

Thursday, June 16, 2011

"Officer Perky visited the residence and saw that the door was ajar. To maintain community security, he went inside. He found a trail of broccoli throughout the house, leading to the bedroom. On top of the dresser in the bedroom was a banana peel, arranged to look like a small shrine..."

Monday, June 13, 2011

Therapist from Child & Family department: "Man! I hate dropping stuff on the floor here, because I have to pick it up!""You don't have to pick it up at home?" I asked."I do, but I have three dogs, so it usually gets eaten first."

Tuesday, May 17, 2011

Lately I've been followed by a slew of nursing students. They spend the day with me at work, (in the words of one student's e-mail) trying to "figure out what mental health nurses do all day."So far, every day on which I have been followed by a student has been extremely slow. It's like the opposite of the old superstition about saying "It's really quiet around here."

When I had a nursing student follow me last week, she got to watch me give one injection, return two phone calls, and fax four prescriptions to pharmacies. Over the course of four hours. No wonder she didn't come back after lunch!

Monday, May 9, 2011

I have a love-hate relationship with GoodbyeNurse. He's a good nurse and a much nicer person than I am. But there's also many days when he absolutely drives me up the wall--and I couldn't pinpoint the reason for love nor money. (Insert Freudian theory about transference/countertransference here.)

As with any co-worker, there's always a dynamic of competition that underlies our working relationship. Nothing overt, but it's always there. Consequently it was childishly gratifying when I announced my upcoming vacation and got the following response from the office goddesses:

"But that means we'll have GoodbyeNurse covering for you! I like you better!" the head of the clerical staff wailed.

As usual, I said the first thing that came to mind. "You guys will be fine. Remember, if you kill him, then I have to train a new nurse, and neither of us wants that!"

Tuesday, April 19, 2011

Officer Perky called my office to tell me about a client who was having multiple contacts with the police on account of his psychosis.

"We've been getting a lot of calls from the neigbors on account of his behavior. He's really making them nervous. The report from last week says he broke into Local Church Campground and announced to everyone that he's the Second Coming of Christ.

"However, Mr. Religious wants to correct his records and he says we were wrong when we did the initial report and he's Jesus' older brother, not Jesus' second coming. Just thought you should know."

Wednesday, March 30, 2011

I called the jail yesterday to follow up on a client who was about to be released. The phone was answered by the perkiest male voice I've ever heard.

"Hi, this is Officer Perky! It's a great day here at Random County Correctional Center!"

"This is HelloNurse calling from County Mental Health about Bonnie Parker's scheduled release tomorrow... What do they put in the coffee over there at the jail? It sounds like you're having way more fun with your job than I am with mine today."

Pause. It lasted so long I almost thought we'd been disconnected until Officer Perky spoke again. "Actually the coffee here is pretty terrible. It's so bad that everything else is wonderful in comparison!"

Sunday, March 13, 2011

A large part of my job is answering phone calls from patients. Sometimes I find myself giving advice that isn't directly related to their current problem, but also needs to be said. My nursing instructors would call this "health teaching," but they probably wouldn't have found themselves fielding calls from inebriated patients seeking more benzodiazepines.

Like on Friday:Ms. Issues: "When is Mr. Casemanager coming by to bring me my medications? I'm having a bad mental health and anxiety day and really need my Xanax."I could tell from the way she was slurring her words that she had been drinking. "Ms. Issues, can you tell me what you've had to drink today?"MI: "Two beers--I know I need to quit, but--"Me: "Actually, I'm way more concerned that it's four in the afternoon and that's all you've had to drink for fluids. Can you tell me anything that you've had to drink today that didn't have alcohol in it?"MI: "Uh.... No, can't think of anything."Me: "Have you had anything to eat today?"MI: "Nope. So is Mr. Casemanager coming by today or not? I'm really having a bad mental health day and need my Xanax."Me: "He'll be by at his usual time, but drinking on an empty stomach usually leads to puking, and then you'll really be having a bad mental health day. Can you fix yourself some toast and drink some water after you hang up with me?""Yeah, I can do that. Tell Mr. Casemanager I said hi!"

Tuesday, March 1, 2011

When I worked in hospitals, there was always a lot of other nurses around to talk to. If Dori wasn't available to answer a quick question, Jim was. If Janice wouldn't help me rob a bank, Ariel would. That sort of thing.

But here at Random County Mental Health, it's just me and GoodbyeNurse. He's a good nurse and a great co-worker, but really doesn't talk much. (I suppose I could always call up the nurses across the street at Random County Public Health if I want to chat with other nurses, but it'd be kind of weird.) One day, I hope to have a conversation with him that isn't work-related that lasts for more than three sentences.

Other than the fact that we're both breathing and we both have a BSN, GoodbyeNurse and I really don't have anything in common. He's a concrete-sequential thinker, organized, quiet, methodical, not one for idle chatter, always spell-checks his e-mails, and enjoys running marathons on his day off. I'm the poster child for high-functioning adult ADHD, embrace being abstract-random like it's a religion, distractable, chatty, have transformed sweet-talking pharmacies into delivering medications to our office into an art form, and will only be found running if someone is chasing me with a weapon. (Have I mentioned tht he doesn't talk much? It's driving me nuts.)

There's days when we work together really well. We split the work load evenly, and cover for the gaps in each other's skill set. It's like yin and yang.

And then there's days (usually the ones where we're forced to share an office space, because neither of us "play well with others") where it's a lot more like Tom and Jerry.

Saturday, February 26, 2011

I can be a bit absent-minded at times. Having a variable schedule that involves traveling between three different offices does not help. There's days when the only way I remember what town I'm supposed to be working in is because the clerical staff tells me.

I misplace a lot of things as well. I've lost everything from jewelry to eyeglasses, but ink pens are the most common lost object. (In a job interview, I once responded to the "what would your co-workers say is your worst trait?" question with "I never know where my pen is and steal theirs.") I compensate by collecting pens and stashing jars of them at all the offices where I work. As long as it writes, I'm not picky.

GoodbyeNurse has a different approach to ink pens. I walked into the County Seat RCMH office yesterday to find him sorting all the pens in the nursing office by color.

"I don't know why we have so many nonstandard pens!" he exclaimed.

Due to the lack of caffeine in my system, I was unable to come up with a response to his comment. I just stared at him.

He apparently took my slack-jawed silence for agreement. "I was taught in nursing school that blue and black ink are the only appropriate color for nursing documentation, so I don't know why we have so many different colors of pen."

"Maybe it's because most of this office's communication is via sticky notes. As long as they're legible, no one cares what color the ink is."

(In retrospect, I should have pointed out that all of our nursing documentation is done on the computer, so the color of the office ink pens is a moot point. Instead, I settled for taking all of the "nonstandard pens" and caching them in my other office, just in case.)

Wednesday, February 23, 2011

On Monday, as I always do, I checked the jail mugshot website to see if any of my patients were guests of the Random County Correctional Center (known around here as "the Country Club.")Then, I called IntimidatingNurse at the jail to see how Bonnie Parker was doing.

The receptionist recognized me by my voice alone when I said hello and immediately put me through.

"Yeah, Bonnie's a bit of a handful, but she stops talking to invisible people as soon as no one's watching her, so we think it's kind of behavioral instead of mental health-related. Don't worry, I've already got her scheduled for a full assessment with IntimidatingShrink this afternoon."

I never dreamed when I applied for this job that I'd be on a first-name basis with the staff of all the local homeless shelters, psych wards (although I really should have seen that one coming,)and the jail.

Thursday, February 10, 2011

In my work for RCMH, I travel between three towns. There's County Seat, Village, and Hamlet. My "office office" (the one where my desk and files are located) is in Village, but I work at the RCMH office in all three locations. I'm only at the main office in County Seat two days a week, but trying to find office space there can be a trial. If there aren't any crises, I can usually use the crisis office. But if they need it for clients, I have a difficult time finding another place with a working computer and phone line.

I can theoretically use the nursing office as my "space," but GoodbyeNurse has already claimed that as his office. We've tried to share an office, but expecting two adults with separate work loads to use the same computer and phone line and get things done is a bit like expecting the Marines to not make fun of the Air Force--you can hope it will happen, but you probably shouldn't bet too much money on it.

My boss has been working on this situation, and he made sure to remind me of that at the med staff meeting this week. His professional approach to the problem was promptly derailed by the rest of the med staff.

"I can find you an office with a nice desk if you'll wear one of those frilly white nursing caps to work," Dr. Analytic quipped.

Wednesday, February 9, 2011

"I called ExpensiveDrug pharmacy to order the medication, but they haven't prescribed for the client since 2004. I then called OverpricedMeds, but the client does not get medications there either. It appears I have failed at playing "guess the phamacy." "

Monday, February 7, 2011

Female crisis worker, talking about a recent patient assessment: "So I said to him, 'Joe, are you seeing anything or hearing anything that you're not quite sure if it's there or not?' And he said 'well, you look really good today.' "

Thursday, February 3, 2011

Part of my job as a nurse is to "coordinate care" between assorted agencies. When it comes to coordinating care between the patient's mental health and medical health providers, it can get complicated and very annoying fast. Usually the process looks something like this:

I call the Primarycaredoc office and wait on hold hearing automated messages about "your call is very important to us. Protect the ones you love by getting a flu shot" for at least five minutes before I get a live person, who will transfer me to someone else.Request the most recent visit note and medication list on Joe Patient."I'm sorry, we need a release of information to give you that information."Check client's computer chart to make sure we have a release. Yes, there is one for Primarycaredoc, and it's been in effect since 2007."We need you to fax us the original copy of it before we can do anything."Find client's paper chart (praying it's not in one of the offices in the other two towns I work in) and fax release to them.Wait 4 hours.Call back to ask them to fax the information. The person I talked to before will be at lunch/on medical leave/abducted by aliens and the staff I talk to will have no idea what needs done.Wait for fax.Blame Primarycaredoc's office when Dr. Warmnfuzzy wants to know what the patient's medical history is before she prescribes large amounts of psychotropic medications to him.Receive fax about ten minutes before our office closes.

Today, I called Dr. Familypractice (part of Primarycaredoc practice) for "the usual" on Joe Patient.A secretary picked up the phone immediately (a real, live person! Squee!) and asked for my fax number, then said she'd "get right on it." Then she asked if I wanted Joe's CT scan results too, or just his most recent laboratory results.And less than three minutes later, the information I wanted over the fax line! It made my day, which reminds me just how boring my life really is. And that I probably should be nicer to Primarycardoc's office staff.

Tuesday, February 1, 2011

When I was in nursing school, my professors repeatedly stressed the need to "think like a nurse."

I still have no idea what they meant by this concept, but I will admit that being a nurse has definitely influenced how I view the universe.

For example, most of my co-workers are middle-aged or older. I love working with them, but the fact that many of them have children my age does create a generation gap that makes small talk difficult sometimes.

So it's always nice for my social skills when the bosses fill open positions with people who are closer to me in age. But when you meet the cute new guy at work and your first thought on meeting him is "He has nice veins--I'd love to start an IV on him!" it's pretty obvious that "nursing" has hijacked large parts of your brain.

It does come in handy sometimes. It's a lot easier to say "Auntie, I know this is awkward, but five years of nursing brainwashing is making me ask you if you and your new boyfriend are using "protection" when sleeping together. You both should probably get checked for STDs, because they're spreading fast in your age group" than "Are you using condoms with the new boyfriend?"

I try to pretend to be like "normal" people, but the nursing mindset may be starting to leak through the cracks. My co-workers are starting to notice.

Like yesterday, when the other nurse and I were setting up a client's medications for the week. One of the social workers wanted us for something.

HIPPA Warning:

No accurate patient information is contained here. If you think you recognize the description of yourself or a friend or family member in these writings, you're mistaken. And if you believe that our patients and co-workers are actually legendary sportsmen, dead politicians, famous generals, or noteworthy thespians, I've got some swampland to sell you.